PROJECT SUMMARY Alcohol misuse is the fourth leading cause of death in the US and a contributing factor to a wide range of health conditions across the lifespan. Oregon state ranks 8th nationally in per capita costs of unhealthy alcohol use, at an annual cost of $919 per Oregonian. Addressing unhealthy alcohol use requires improved use of PCOR evidence in primary care clinics ? including screening and brief intervention (SBI), medication assisted treatment (MAT), and referral to treatment (RT) ? as part of routine care. ANTECEDENT (pArtNerships To Enhance alCohol scrEening, treatment, anD intErveNTion) leverages the established infrastructure of the Oregon Rural Practice-based Research Network (ORPRN) and SBIRT Oregon to improve SBI and MAT in small to medium sized primary care clinics in Oregon. We partner with the Oregon Health Authority (OHA) Transformation Center and align our approach with state and regional Medicaid reform efforts ? which in January 2019 will include SBIRT as an electronic health record reported quality incentive metric. Implementation support will be delivered using practice facilitation as a central and unifying strategy. All clinics will receive Foundational Support which includes access to an online implementation toolkit and 6- months of tailored Supplemental Support designed to address clinic-specific gaps in care through strategies such as practice facilitation, health information technology (HIT) support and peer-to-peer learning. Our implementation process is informed by a hybrid conceptual model of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Dynamic Sustainability Framework (DSF). We use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to support our evaluation. Our specific aims are to: (1) Engage, recruit, and conduct intake consultations with 150 primary care clinics and their regional CCOs within the state of Oregon; (2) Implement and describe how practice facilitators tailor implementation support based on context, intervention, and personal expertise using mixed methods and systems science; and (3) Evaluate the impact of foundational and supplemental implementation support on SBI, MAT, and QI capacity in participating primary care clinics. ANTECEDENT bridges improvement science and implementation science ? allowing for local change and the production of generalizable knowledge. Our multi-method evaluation will support participation in the external evaluation and enable a robust internal evaluation. ANTECEDENT addresses knowledge gaps regarding practice facilitator expertise and leverages state context to build primary care QI capacity and increase SBI and MAT for unhealthy alcohol use.